On World AIDS Day: the European Union and United States Emerge on Opposite Sides of the HIV-Prevention Debate

The theme of this year's World AIDS Day, Stop AIDS: Keep the Promise, encouraged governments to reevaluate their commitments to fighting HIV/AIDS both at home and worldwide. Reemphasizing old promises gave rise to a new, clear divide on the approach to HIV prevention between two of the world's major donors, the United States and the European Union (EU).

The Bush Administration highlighted the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's framework since 2004 for addressing the global AIDS pandemic that includes funding for 15 focus countries in Africa and the Caribbean as well as Vietnam. The president claimed the U.S. government is “keeping its promise to support prevention of new HIV infections.” In his World AIDS Day address, the U.S. President focused on mother-to-child prevention programs, but did thank the “people who run youth groups and clubs that encourage abstinence and help children with HIV face the challenges of life.” He said, “many of these good people who serve others are also motivated by their deep faith. And we want to expand these partnerships.”1

A news brief by the Office of the Global AIDS Coordinator (OGAC) offered more specific examples of these efforts to prevent infection among young people, showcasing the PEPFAR-supported Mobilizing Youth for Life programs run by World Relief in Kenya, Haiti, Mozambique, and Rwanda. According to OGAC, the program “seeks to challenge and equip more than 1.8 million youth ages 10–24 to choose abstinence before marriage and faithfulness in marriage as the best prevention against the spread of HIV and other sexually transmitted diseases. The program also helps 200,000 ‘influencers' of youth—parents, guardians, pastors, teachers, and youth leaders—to guide youth to make and sustain wise life choices about their sexual behavior.”2According to the organization's website, World Relief conducts HIV prevention through its AIDS ministries, which work to educate people about “the dangers of promiscuity and the spread of the virus—teaching God's design for a faithful monogamous relationship through marriage.”3 In Kenya, Mobilizing Youth for Life has already distributed 50 abstinence pledge cards to nine youth clubs.4 Abstinence pledge cards, also known as virginity pledges, have not been proven effective domestically. This effort is part of a broader five-year program involving several organizations across the 15 focus countries that seeks to decrease HIV transmission among young people by reaching them with messages about abstinence and fidelity.

Across the Atlantic, the EU released a World AIDS Day statement that, although not naming the Bush Administration, directly challenges the exportation of such U.S.-styled abstinence-until-marriage initiatives into the global HIV-prevention policy arena. On November 24 at a meeting under the United Kingdom presidency of the EU in London, the 22 member states of the EU released a statement calling on world governments to “utilize all approaches known to be effective, not implementing one or a few selective actions in isolation,” among these “universal access to education and provision of life-skills and sexuality education and action to promote increased safety in schools for all children.”5

The governments of the EU generally reaffirmed their pre-existing commitments to address HIV/AIDS both within the EU and internationally, and more specifically, committed “to address the HIV prevention gap, which left unchecked will undermine the whole AIDS response.”6 “HIV prevention requires governments and communities have the courage to confront difficult issues in an open and informed way. We understand that in many settings there is a cultural resistance to openly discussing sex, sexuality, and drug use. We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness.”

The international development secretary for the UK , Hilary Benn, said that the evidence has shown what works to stop HIV/AIDS, from tackling stigma to supplying condoms and clean needles. As for promoting abstinence to the exclusion of other prevention information, he commented, “abstinence works if people can abstain, but I don't think people should die because they have sex. We need to make sure people have all the means [of prevention] at their disposal—condoms and clean needles. It includes education and access to sexual and reproductive health services.”7

“The myopic policies of the current U.S. government are keeping millions ignorant of how to protect themselves from HIV, and HIV/AIDS advocates worldwide must work double-time to counteract negative ramifications,” said vice president for public policy at SIECUS, William Smith . “Advocates in the U.S. and worldwide are grateful for the governments of Europe that step-up and fill the decency gap left by wayward U.S. funding and policies, including the proliferation of abstinence-until-marriage programs in Africa. As a major donor supporting the full range of sexual and reproductive health and rights, the EU also has the capacity to mitigate pressure on governments in the Global South to adopt an abstinence-only approach,” Smith continued.

Critical Interventions: Prevention: The U.S. Government is keeping its promise to support prevention of new HIV infections . . ., ( Washington , DC : Office of the Global AIDS Coordinator, 2005) accessed 5 December 2005, <http://www.state.gov/>.